title: The role of liver biopsy in the diagnosis and prognosis of patients with acute deterioration of alcoholic cirrhosis.
abstract: OBJECTIVE
  The aim of this study was to systematically assess the diagnostic and prognostic value of early liver biopsy in patients who require hospital admission with acute deterioration of alcoholic cirrhosis.
  
  
  METHODS
  Sixty-eight patients with acute deterioration of alcoholic cirrhosis underwent a liver biopsy within 7 days and the biopsies were processed using routine stains and K8/18 immunohistochemistry to characterize balloon degeneration. The biopsies were scored by two independent histopathologists using pre-defined criteria. The patients were managed according to institutional protocols and followed until the time of hospital discharge or death.
  
  
  RESULTS
  With use of K8/18 immunohistochemistry, very high concordance rate for the diagnosis of balloon degeneration was reached (r = 0.7; p = 0.0001). The presence of a systemic inflammatory response (SIRS) suggestive of acute alcoholic steatohepatitis (ASH), predicts severe ASH histologically in only 50% patients. Moreover, in 41% of SIRS negative patients who were thought not to have ASH, a diagnosis of ASH was subsequently confirmed on histological grading. Patients that have SIRS criteria but no evidence of histological ASH are more likely to develop infection which may be indicated by the severity of canalicular cholestasis. Nineteen patients died during follow up. Patients manifesting ASH on biopsy who were also SIRS positive, had a significantly greater risk of mortality compared to those that were SIRS positive but ASH negative (p < 0.01) and those that were SIRS negative (p < 0.0001).
  
  
  CONCLUSIONS
  The use of K8/18 immunostaining allows grading of the severity of alcoholic steatohepatitis. Early liver biopsy in these patients presenting with acute deterioration of cirrhosis is safe and provides important diagnostic and prognostic information.
authors.affiliation: UCL Institute of Hepatology, UCL Medical School, Royal Free Hospital, United Kingdom. r.mookerjee@ucl.ac.uk
authors.forename: Rajeshwar P
authors.initials: RP
authors.lastname: Mookerjee
authors.forename: Caroline
authors.initials: C
authors.lastname: Lackner
authors.forename: Rudolf
authors.initials: R
authors.lastname: Stauber
authors.forename: Vanessa
authors.initials: V
authors.lastname: Stadlbauer
authors.forename: Moesha
authors.initials: M
authors.lastname: Deheragoda
authors.forename: Ariane
authors.initials: A
authors.lastname: Aigelsreiter
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jalan
mesh_terms: D000208:Acute Disease; D000704:Analysis of Variance; D001706:Biopsy; D018450:Disease Progression; D005235:Fatty Liver, Alcoholic / Q000150:complications* / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D053538:Keratin-18 / Q000276:immunology; D053533:Keratin-8 / Q000276:immunology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications*
chemical_list: D053538:Keratin-18; D053533:Keratin-8